A blunt complex abdominal trauma: total hepatectomy and liver transplantation

Abstract

A victim of a motor accident was referred to the Emergency Department. He was unconscious, breathing was rapid and shallow, and had a mean arterial pressure of 60 mmHg with a distended abdomen. A peritoneal lavage was positive for blood. An immediate laparotomy showed a massive hepatic injury with bilobar disruptions. After an unsuccessful hepatorrhaphy an extensive perhepatic gauze packing was done. During the operation the patient was massively transfused and high doses of dopamine were used. At the end a relative stability was reached, but a few hours later, due to the high risk of sepsis and abdominal compartment syndrome, a second laparotomy was performed. Despite efforts to reach a good hemostasis, it was decided to perform a total hepatectomy and portocaval shunt. The patient was put on the waiting list for a compatible liver. After 36 h in this anhepatic state, the patient received the new graft. The graft showed immediate recovery. In cases of severe and complex liver trauma, performing a total hepatectomy followed by liver transplantation is justified.

Liver Transplantation Due to Abdominal Trauma

“…injuries of the liver's veins or the bile duct system, and a liver insufficiency caused by trauma, e.g. shock liver, allow for the consideration of LT (51,52).…”

Liver transplantation for severe hepatic trauma: Experience from a single center

“…The indications for liver transplantation in the setting of severe and complicated liver trauma, reported in the literature are: (1) uncontrollable bleeding despite repeated previous surgical interventions; (2) postoperative evolution towards hepatic insufficiency (acute or progressive); (3) injuries of the portal vein that cannot be reconstructed [4,5,[9][10][11][12][13] . In our series, the indications for OLT were the following: portal hypertension due to portal thrombosis and arterio-venous shunt; liver failure from massive injury; and portal thrombosis and liver gangrene with pseudo-aneurysm formation (Table 2).…”

Management of liver trauma in adults

“…[61–65] Since the mortality rate associated with these injuries is extremely high and there is a shortage of organs available for procurement as well, the indication for liver transplantation is very restricted. Most of the indications described in the literature are uncontrolled bleeding despite repeated previous surgery and acute or progressive liver failure following repair of injury.…”